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Benefits of Program Benefits of Program Collaboration, Service Collaboration, Service
Integration and Data SharingIntegration and Data Sharing
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STD/HIV Collaboration MilestonesSTD/HIV Collaboration Milestones
• 1987 - STD and HIV Programs adopt unified effort to maximize PS capacity.
• 1987 – PS offered to CHD HIV+ clients by STD Program DIS.
• 1997 – HIV Reporting (July 1997)
• 1998 - PS for HIV+ clients increased 46%.
• 2002 – Policy Change- PS Offered to all HIV + Persons Tested Through C/T Sites.
• 2008 – Automated HIV/STD record search capability via PRISM and HARS.
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Data Encryption
Access Controls
State Policy and Guidelines
Physical Security
*************************************************************************************************
Florida’s confidentiality and security exists to protect the individual and their medical information, regardless of the disease, as part of common practice in modern public health programs.
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Physical Security
Virtual Security
• Hardware (server) locked within Data Center Building.
• Limited Access to building with monitored entrance 24/7.
• Background checks and security clearance policy.
• Agency/Program confidentiality and information security policies
• Firewalls –•Active Antivirus, •Security web scanning •Behavior level monitoring •Software to ensure latest security updates• Network security that includes:
• User accounts with applied security access •Software level user identification and security controls
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Device registered on Network
Device registered on Network
VPN – Encrypted Connection
Mobile Connection:
• Device registration
• User Authentication
• Software Authentication
• Window to Data – Nothing resident on Device Memory
Modern Web Applications/BSTD and Area STD Programs: share security levels with internal network devices, in addition to encrypted VPN tunnels and no data stored on the device (simply a view into software and data on the server).
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Holistic Client
Centered
PCSI:Program Collaboration and
Service Integration
Systems and Information Technology Maturity Model:
Integrated Systems and Data Sharing
Future: Health Information and
Electronic Health Records
Past: Silo systems and databases divided by
disease
Healthy Evolution – long term sustainability
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Rationale for Integration in the Delivery and Rationale for Integration in the Delivery and Management of STD/HIV Partner ServicesManagement of STD/HIV Partner Services
• 10+ Years of steady decline in federal, state and local resources
• Combined resources to maximize prevention impact
• Significant overlap in populations served
• Significant and increasing STD/HIV co-infection
• Standardization of information security policies and procedures across disease control programs
• Vastly Improved performance outcomes through information exchange between STD and HIV Programs
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Reported STD Cases by sex, among clients who had a + HIV test on, or prior to the date of their STD
diagnosis. Florida, 2005-2011
0
500
1,000
1,500
2,000
2,500
3,000
3,500
2005 2006 2007 2008 2009 2010 2011
Female
Male
Total
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Infectious Syphilis and HIV Co-infection Florida, 2000 to 2011
369434
505 490 509 533 506
675 703 684 66672740
64
118 164207 197 209
242
338 357
519
523
0
200
400
600
800
1,000
1,200
1,400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
9.8%
12.9%
18.9%
26.9%29.2%
26.3%
32.4% 34.2%
35%41.8%
Syphilis Alone Syphilis/HIV Co-infection
25%
29%
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Inter-program and Technology Advances to Improve Service Delivery and Performance
Outcomes
• Standardization of Information Security Policies to allow
for automated information exchange across Disease
Control Programs. (All DOH staff accountable!!)
• Reciprocal data exchange between STD/AIDS
Surveillance = Reduction in NIRs and improved
intelligence for HIV Partner Services
• Electronic lab reporting to reduce STD Prevention and
PS timeframes
• Ability to conduct virtual QA/QI via PRISM
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Inter-program and Technology Advances to Inter-program and Technology Advances to Improve Service Delivery and Performance Improve Service Delivery and Performance
OutcomesOutcomes• AIDS Surveillance monitors clients with subsequent STD
infections via PRISM
– Included in Annual Epi-profiles
– Used as key variable to evaluate “Prevention for
Positives” initiatives and to guide resource allocation
• Testing and Treatment History for Incidence Surveillance
– DIS collect previous testing and antiretroviral use
during PS sessions. Information used by AIDS
Surveillance when calculating incidence estimates
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ELRELR and Data Sharing = Reduced and Data Sharing = Reduced Timeframes for HIV Partner ServicesTimeframes for HIV Partner Services
0
10
20
30
40
50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number Days Specimen Collect to Assigned for Partner Services
ELR Expansion
PRISM
STD to HARS
1717
4747
AIDS Surveillance
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2010 HIV Partner Services - Florida2010 HIV Partner Services - Florida
New HIV+ PS Interviews
743
1833
CHD Non-CHD
New and Previous + PS Interviews
1355
3029
CHD Non-CHD
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Reported Adult HIV (not AIDS) Cases, FloridaReported Adult HIV (not AIDS) Cases, Florida
33%
8%
32%
25%
2%0%
Men Sex W/Men (MSM)
Injecting Drug Use (IDU)
MSM/IDU
Other
Heterosexual
Risk Not Reported orIdentified
41%
7%2%
32%
16%
2%
Through 2005N=35,584
Through 2010N=44,957
Note: NIRs NOT redistributed.
Data as of 06/30/2011Data as of 12/31/2005
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PCSI is absolutely essential for PCSI is absolutely essential for disease control programs todisease control programs to::
– Maximize resources/increase efficiency
– Standardize and improve on information security
policy and procedures (Fosters mutual
confidence across programs that information will
remain secure.
– Reach the greatest proportion of infected and
exposed persons through PS, referral, link to
services
– Provide holistic prevention services to clients